Healthcare Provider Details

I. General information

NPI: 1205118023
Provider Name (Legal Business Name): REINILDA RIVERA MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2011
Last Update Date: 04/07/2024
Certification Date: 04/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. PARK GARDENS Y-20 CALLE YELLOWSTONE
SAN JUAN PR
00926-2221
US

IV. Provider business mailing address

URB. PARK GARDENS Y-20 CALLE YELLOWSTONE
SAN JUAN PR
00926-2221
US

V. Phone/Fax

Practice location:
  • Phone: 787-399-7375
  • Fax:
Mailing address:
  • Phone: 787-399-7375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number1566
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: